Case 1: Lack of choice in interventions leading to a complaint of unprofessional conduct
March 26, 2026
Allegation
The patient was in a motor vehicle collision and sought physiotherapy services on the recommendation of their insurance provider.
The patient had prior experiences with a different physiotherapist and stated that dry needling of the lower back should have been the focus of the treatment plan following their motor vehicle collision.
The patient stated that the physiotherapist had confidential conversations in public areas of the physiotherapy clinic, told others about the patient’s condition without the patient’s consent, and provided false information to other health-care providers.
The College investigated two allegations:
- Over a seven-month period, the physiotherapist did not collaborate with the patient to develop a realistic intervention plan to address the patient’s goals.
- Over a seven-month period, the physiotherapist communicated with the patient and other members of the patient’s health-care team (a massage therapist and a physiotherapist) in a manner that was disrespectful and dishonest.
The Complaints Director notified both parties at the onset of the investigation that the College would not specifically investigate why dry needling was not used as a physiotherapy intervention for the patient’s reported lower back symptoms as the College is clear on the College website that it cannot get involved in directing a patient’s clinical care plan.
The Complaints Director communicated to the parties that the focus of the investigation for Allegation #1 would be on whether or not the physiotherapist met the expected outcome of the Client Assessment, Diagnosis, Interventions Standard of Practice (2017 edition) that clients can expect the physiotherapist to select appropriate assessment tools, make an informed physiotherapy diagnosis, and apply intervention procedures that are carried out proficiently for quality delivery of physiotherapy services.
Investigation
Allegation #1
The investigation focused on the physiotherapist’s rationale for their treatment plan and how that treatment plan was communicated to the patient.
The investigation provided evidence that the patient had provided their consent to proceed with the proposed treatment plan and that dry needling and acupuncture were part of that treatment plan. While the frequency of use of dry needling may not have satisfied the patient, the physiotherapist provided their rationale and used their professional judgment to determine the appropriate frequency of use for this patient. No evidence was provided to contradict this rationale.
Examination of the physiotherapy record showed that the physiotherapist documented unique subjective reports from the patient for each attendance and adjusted the physiotherapy services provided to address the unique subjective report. The physiotherapy record also documented that treatment goals were set at the beginning of the episode of care and reevaluated on a regular basis.
The patient and the physiotherapist had differing recollections of how their communication about treatment goals and choices of interventions occurred. The physiotherapy record documented the physiotherapist’s rationale for choosing certain interventions and for not choosing others. The physiotherapy record also documented when the treatment plan or components of the treatment plan were communicated to the patient.
Allegation #2
The patient provided written consent for the physiotherapist to share personal and medical information with others.
The patient’s consent for the physiotherapist to speak with their massage therapist was also documented in the physiotherapy record.
The massage therapist was questioned, and they did not recall any communication with the physiotherapist that supported the allegation.
There was no evidence collected to support that the physiotherapist spoke with another physiotherapist about the patient.
Decision
Allegation #1
There was no evidence to support the allegation.
The physiotherapy record demonstrated that a treatment plan was established, the rationale was communicated to the patient, the patient’s subjective reports and responses to interventions was considered, and the treatment plan was regular re-assessed and modified accordingly.
Allegation #2
There was no evidence to support the allegation.
The physiotherapy record documented consent to release information in writing and verbally to the massage therapist.
The patient alleged that the physiotherapist discussed confidential information in the waiting area of the clinic. The physiotherapist stated that any conversations that began in the waiting area of the clinic and were pertaining to confidential or sensitive information were immediately moved to a private treatment area.
Key Message
If your treatment plan or intervention choices do not align with what the patient thinks or feels they should be receiving as part of their physiotherapy services, be sure to document your conversations including outlining your rationale for your decision. This will be strong evidence in the professional conduct process.
Given the nature of the physical layout of physiotherapy clinics and departments, be sure to conduct sensitive or confidential conversations in private areas.
Case 2: A patient was burned, but was it due to unprofessional conduct?
February 11, 2026
Allegations
The patient attended physiotherapy services. Heat packs and K-tape were used regularly with the patient. Three days after the provision of physiotherapy services, the patient noted a skin injury / blister / burn on their shoulder and attributed this injury to the heat pack used as part of the physiotherapy services provided by the physiotherapist. The physiotherapist opined that the injury to the patient’s skin was not from the heat pack but was a friction burn from the K-tape.
Two allegations were investigated:
- The physiotherapist failed to safely apply a thermal modality to the patient’s right shoulder, and this resulted in a burn to the patient’s right shoulder.
- The physiotherapist failed to safely use K-Tape as a physiotherapy intervention to the patient’s right shoulder.
Investigation
The investigation gathered evidence that demonstrated the following:
- A heat pack was utilized on each attendance of the patient, including the last appointment before the skin injury was discovered.
- K-tape was utilized on ten occasions, including the last appointment before the skin injury was discovered.
- Thermal sensation testing had been performed but was not documented.
- The patient’s skin condition before and after the application of the heat pack and before and after the application of the K-tape was not documented.
- The temperature of the water in the hydrocollator used by the physiotherapist was tested and documented at a safe temperature in the days leading up to the incident but not on the date of the incident itself.
- No medical conditions were documented that would preclude the use of heat packs or K-tape.
- No changes in health status were reported by the patient or documented by the physiotherapist on the date of the incident that would have made the use of a heat pack or K-tape an unsafe choice on the date in question.
There was disagreement between the patient and the physiotherapist as to whether towels were used with the heat pack or not with the physiotherapist stating towels were used and the patient not recalling whether towels were used.
The patient and the physiotherapist agreed that the patient was instructed to remove the K-tape if it was irritating the skin. The patient recalled being told the K-tape would fall off in the shower. The physiotherapist was more detailed in their description of how to remove the K-tape safely. There was no documentation in the physiotherapy record regarding effects, complications, or safe removal of the K-tape.
Decision
Given that heat packs and K-tape had been used throughout the episode of care prior to the patient’s final attendance; that no evidence was collected to suggest a change in the patient’s health status that would have contraindicated their use on the date in question; that equal weight was given to the recollections of both the patient and the physiotherapist regarding the redness of the patient’s skin following the heat pack and the assessment undertaken before applying the K-tape; and that the physiotherapist described a safe and effective method of K-tape application, with both parties recalling appropriate removal of the tape, the Complaints Director did not consider there to be sufficient evidence of unprofessional conduct to substantiate either allegation, nor that further investigation would be likely to yield additional evidence.
Neither allegation was referred for a Hearing Tribunal, and the complaint was dismissed.
The physiotherapist was provided with the following recommendations to improve their practice:
- Review and reflect on the Documentation Standard of Practice and ensure that they are documenting the following with sufficient detail to support their interactions with patients and their version of events:
- Patient medical history.
- Thermal sensation testing.
- The use of K-tape.
- The education provided to patients about precautions specific to K-tape.
- The patient’s response to K-tape.
- The patient’s response to the application of a heat pack.
Finally, because of the evidence collected in this matter, the Complaints Director also recommended that the physiotherapist consider the frequency that they are applying K-tape in practice, particularly in situations where other modalities are utilized and skin integrity could be compromised and review current evidence to support their use of K-tape in their physiotherapy practice.
Key Message
Physiotherapists should clearly document whether sensation testing was done, especially thermal testing.
Physiotherapists should clearly document instructions given to patients regarding the removal of K-tape and other supportive products.
In cases where multiple modalities are being used that can impact skin integrity, consider the risks and benefits of using such modalities in combination and educate your patients accordingly.
